Decline in Kidney Function among Apparently Healthy Young Adults at Risk of Mesoamerican Nephropathy.

Background Epidemic levels of CKD of undetermined cause, termed Mesoamerican nephropathy in Central America, have been found in low- and middle-income countries. We investigated the natural history of, and factors associated with, loss of kidney function in a population at high risk for this disease.Methods We conducted a 2-year prospective, longitudinal study with follow-up every 6 months in nine rural communities in northwestern Nicaragua and included all men (n=263) and a random sample of women (n=87) ages 18-30 years old without self-reported CKD, diabetes, or hypertension. We used growth mixture modeling to identify subgroups of eGFR trajectory and weighted multinomial logistic regression to examine associations with proposed risk factors.Results Among men, we identified three subpopulations of eGFR trajectory (mean baseline eGFR; mean eGFR change over follow-up): 81% remained stable (116 ml/min per 1.73 m2; -0.6 ml/min per 1.73 m2 per year), 9.5% experienced rapid decline despite normal baseline function (112 ml/min per 1.73 m2; -18.2 ml/min per 1.73 m2 per year), and 9.5% had baseline dysfunction (58 ml/min per 1.73 m2; -3.8 ml/min per 1.73 m2 per year). Among women: 96.6% remained stable (121 ml/min per 1.73 m2; -0.6 ml/min per 1.73 m2 per year), and 3.4% experienced rapid decline (132 ml/min per 1.73 m2; -14.6 ml/min per 1.73 m2 per year; n=3 women). Among men, outdoor and agricultural work and lack of shade availability during work breaks, reported at baseline, were associated with rapid decline.Conclusions Although Mesoamerican nephropathy is associated with agricultural work, other factors may also contribute to this disease.

Rationale, description and baseline findings of a community-based prospective cohort study of kidney function amongst the young rural population of Northwest Nicaragua.

BACKGROUND: An epidemic of Mesoamerican Nephropathy (MeN) is killing thousands of agricultural workers along the Pacific coast of Central America, but the natural history and aetiology of the disease remain poorly understood. We have recently commenced a community-based longitudinal study to investigate Chronic Kidney Disease (CKD) in Nicaragua. Although logistically challenging, study designs of this type have the potential to provide important insights that other study designs cannot. In this paper we discuss the rationale for conducting this study and summarize the findings of the baseline visit. METHODS: The baseline visit of the community-based cohort study was conducted in 9 communities in the North Western Nicaragua in October and November 2014. All of the young men, and a random sample of young women (aged 18-30) without a pre-existing diagnosis of CKD were invited to participate. Glomerular filtration rate (eGFR) was estimated with CKD-EPI equation, along with clinical measurements, questionnaires, biological and environmental samples to evaluate participants' exposures to proposed risk factors for MeN. RESULTS: We identified 520 young adults (286 males and 234 females) in the 9 different communities. Of these, 16 males with self-reported CKD and 5 females with diagnoses of either diabetes or hypertension were excluded from the study population. All remaining 270 men and 90 women, selected at random, were then invited to participate in the study; 350 (97%) agreed to participate. At baseline, 29 (11%) men and 1 (1%) woman had an eGFR <90 mL/min/1.73 m2. CONCLUSION: Conducting a community based study of this type requires active the involvement of communities and commitment from local leaders. Furthermore, a research team with strong links to the area and broad understanding of the context of the problem being studied is essential. The key findings will arise from follow-up, but it is striking that 5% of males under aged 30 had to be excluded because of pre-existing kidney disease, and that despite doing so 11% of males had an eGFR <90 mL/min/1.73 m2 at baseline.

Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy.

BACKGROUND: Mesoamerican nephropathy is a leading contributor to premature mortality in Central America. Efforts to identify the cause are hampered by difficulties in distinguishing associations with potential initiating factors from common exposures thought to exacerbate the progression of all forms of established chronic kidney disease (CKD). We explored evidence of disease onset or departure from the healthy estimated glomerular filtration rate distribution [departure from ∼eGFR(healthy)] in an at-risk population. METHODS: Two community-based cohorts (adults aged 18-30 years, n = 351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3 years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from ∼eGFR(healthy), using a hidden Markov model. RESULTS: CKD occurred in men only (male incidence rate: 0.7%/year). Fifty-three (out of 1878 visits, 2.7%) and 8 (out of 1067 visits, 0.8%) episodes of probable departure from ∼eGFR(healthy) occurred in men and women, respectively. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure were associated with incident CKD. The same exposures were associated with probability of departure from ∼eGFR(healthy) in time-updated analyses along with measured and self-reported weight loss, nausea, vomiting and cramps, as well as non-steroidal anti-inflammatory drug use. CONCLUSIONS: CKD burden in this population is high and risk factors for established disease are occupational. Additionally, a syndrome suggesting an alternative exposure is associated with evidence of disease onset supporting a possible separate unknown initiating factor for which further investigation is needed. Interventions to reduce the impact of occupational risks should be pursued meanwhile.

Suppression of Midgut Microbiota Impact Pyrethroid Susceptibility in Aedes aegypti.

Aedes aegypti is a mosquito that transmits viral diseases such as dengue, chikungunya, Zika, and yellow fever. The insect's microbiota is recognized for regulating several biological processes, including digestion, metabolism, egg production, development, and immune response. However, the role of the bacteria involved in insecticide susceptibility has not been established. Therefore, the objective of this study was to characterize the resident microbiota in a field population of A. aegypti to evaluate its role associated with susceptibility to the insecticides permethrin and deltamethrin. Mosquitoes were fed 10% sucrose mixed with antibiotics and then exposed to insecticides using a diagnostic dose. DNA was extracted, and sequencing of bacterial 16S rRNA was carried out on Illumina® MiSeq™. Proteobacteria (92.4%) and Bacteroidetes (7.6%) were the phyla, which are most abundant in mosquitoes fed with sucrose 10%. After exposure to permethrin, the most abundant bacterial species were Pantoea agglomerans (38.4%) and Pseudomonas azotoformans-fluorescens-synxantha (14.2%). Elizabethkingia meningoseptica (38.4%) and Ps. azotoformans-fluorescens-synxantha (26.1%) were the most abundant after exposure to deltamethrin. Our results showed a decrease in mosquitoes' survival when exposed to permethrin, while no difference in survival when exposed to deltamethrin when the microbiota was modified. We found that the change in microbiota modifies the response of mosquitoes to permethrin. These results are essential for a better understanding of mosquito physiology in response to insecticides.

Control de la terapia anticoagulante en prótesis valvulares cardiacas / Anticoagulant therapy control

Objetivo. Evaluar la eficacia de dos pruebas de laboratorio empleadas para el control de la terapia anticoagulante de pacientes con prótesis valvulares cardiacas. Material y métodos. Se revisaron 240 notas médicas y 240 resultados de laboratorio provenientes de 20 pacientes (12 mujeres y ocho hombres). Se registraron los datos concernientes con el tiempo de protrombina y la relación internacional normalizada (RIN) recabados durante 12 controles mensuales. Fueron comparados los resultados de las pruebas de laboratorio con los episodios de sangrado. Se determinó el valor predictivo positivo, el valor predictivo negativo, la sensibilidad, la especificidad y la eficacia global de las pruebas en reto. Resultados. Se documentaron 25 episodios de sangrado: 20 fueron menores (80 por ciento) y cinco mayores (20 por ciento). De estos episodios, 18 ocurrieron con un tiempo de protrombina adecuado; en estos casos, el valor predictivo positivo fue de 15 por ciento, el valor predictivo negativo de 94 por ciento, la sensibilidad de 72 por ciento; la especificidad de 52 por ciento y la eficacia global de 54 por ciento. En cambio hubo 14 episodios con RIN recomendable y 11 con una RIN mínima efectiva; el valor predictivo positivo fue de 11 por ciento; el valor predictivo negativo de 90 por ciento; la sensibilidad de 56 por ciento, la especificidad de 50 por ciento y la eficacia global de 51 por ciento con p<0.05. Conclusiones. El tiempo de protrombina tiene mayor eficacia global que la relación internacional normalizada. Existe una relación directa entre la intensidad de la anticoagulación y los episodios de sangrado

Esquema terapéutico en la faringoamigdalitis / Therapeutic plan for pharyngoamygdalitis

Con el objetivo de revisar la utilidad de los datos clínicos para el diagnóstico y tratamiento de las faringeoamigdalitis agudas se realizó un estudio que comparó dos grupos: grupo I tratado de acuerdo a esquema terapéutico (esquema tradicional de otorrinolaringología) y grupo II tratado indiscriminadamente con antibióticos. Los resultados de este estudio nos permitió observar que en la práctica diaria, el empleo del criterio clínico es de mayor utilidad. Se propone el esquema de tratamiento clínico para brindar mayor beneficio diagnóstico y evitar el uso indiscriminado de antibióticos

Diagnóstico y tratamiento de la otitis serosa recurrente / Diagnosis and treatmen of recurrents serous otitis media

El objetivo de este estudio es comparar la utilidad del manejo médico contra el tratamiento quirúrgico en la otitis media serosa recurrente, y valorar la importancia del examen audiológico en esta patología. Mediante ensayo clínico controlado, se formaron dos grupos de 50 pacientes cada uno; se utilizó tratamiento médico convencional en uno (grupo 1) y timpanotomía con colocación de tubo de ventilación en el otro (grupo II). Este último mostró un éxito terapéutico significativo con p<0.0002 cuando se comparó con el grupo I de una mayor incidencia de complicaciones auditivas con p<0.0001. El tratamiento convencional se acompaño de un elevado porcentaje de complicaciones, por lo que el manejo quirúrgico puede ser una alternativa en este tipo de patología.

Empleo de endoscopia en adenoidectomía / The use of endoscopy for adenoidectomy

Objetivo: evaluar la utilidad de la endoscopia en adenoidectomía. Diseño: ensayo clínico controlado. Se formaron dos grupos de 40 pacientes cada uno, que serían sometidos a adenoidectomía. En el grupo I se utilizó el método convencional con endoscopia y en el grupo II, sin endoscopia. En el grupo I no se registraron sangrados, mientras que en el grupo II se presentaron 22 sangrados menores posteriores al procedimiento (p < 0.0001) y siete recidivas (p < 0.01). Se propone el uso de endoscopia en adenoidectomía para evitar recidivas y disminuir el riesgo de sangrado

Síncope vagotónico. Manejo con bromuro de propantelina / Treatment of vasovagal syncope with propanthelin bromide

Objetivo: Demostrar la eficacia terapéutica del bromuro de propantelina para evitar recurrencia en síncope vagotónico. Lugar: HGZ No. 3 IMSS, Mazatlán, Sinaloa, México de 1992 a 1995. Pacientes: De 41 pacientes con síncope se incluyeron 10 con síncope vagotónico. Diseño: longitudinal prospectivo. Procedimiento: Se realizó historia clínica, valoración cardiológica y neurológica, electrocardiograma, electroencefalograma, T.A.C., Holter, prueba de esfuerzo y Rx de tórax. Se realizó seguimiento de 10 pacientes por espacio de 12 meses y se midió recurrencia, mejoría de síntomas clínicas y efectos colaterales de bromuro de propantelina 15 a 30 mg cada 8 horas vía oral. Resultados: De 10 pacientes 7 son mujeres, edad promedio 18 años, no hubo recurrencia de síncope en 9 de ellos (p < 0.005), 1abandodó tratamiento, 4 con efectos colaterales leves. Conclusiones: El bromuro de propantelina disminuye la recurrencia de síncope vagotónico con pocos efectos colaterales a 1 año de seguimiento

Faringoamigdalitis aguda. Su tratamiento / Treatment for acute pharungotonsillitis

Con el objeto de evaluar la utilidad de tres distintos esquemas terapéuticos en la faringoamigdalitis aguda (FAA) no purulenta, se realizó un ensayo clínico controlado que comparó tres grupos de 30 pacientes cada uno: grupo A con tratamiento sintomático, grupo B tratado con penicilina procaínica por siete días más medicamentos sintomáticos, grupo C tratado con penicilina procaínica por dos días y con penicilina benzatínica por dos días y con penicilina benzatínica al tercer día, y sintomáticos. Este estudio nos permitió observar que no existieron diferencias estadísticamente significativas cuando comparamos los tres grupos, p> 0.6, p> 0.6 y p> 1, respectivamente. Se propone el tratamiento sintomático en la FAA para brindar mayor beneficio terapéutico y evitar el uso indiscriminado de antibióticos en la consulta de medicina familiar